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Med Surg > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

6 P’s of neurovascular assessment

A

pain
pallor
pulselessness
paresthesia
paralysis
poikilothermia

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2
Q

inability to maintain a core temperature

A

poikilothermia

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3
Q

acute pain is less than ____ months, but chronic is greater than ___ months

A

3

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4
Q

COLDSPA

A

characteristics
onset
location
duration
severity
pattern
associated/aggravating factors

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5
Q

class of medication to avoid with GI bleeds and renal disease

A

NSAIDs

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6
Q

specific NSAID to avoid with renal disease

A

acetaminophen (Tylenol)

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7
Q

Tylenol has a high risk for ______ and can cause serious _____ damage

A

overdose, liver

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8
Q

Tylenol overdose is treated with IV ____

A

NAC (N-acetylcysteine)

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9
Q

8 S/E to be aware of with opioids

A

constipation
respiratory depression
sedation
GI upset (N/V)
addiction
pruritis
hypotension
withdrawal

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10
Q

you should administer geriatric patients _____ doses of pain medications because they do not metabolize them as quickly

A

lower

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11
Q

2 risks/side effects associated with pain medication that elderly people are at greater risk for

A

falls
respiratory depression

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12
Q

most common MS complaint

A

back pain

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13
Q

7 nonpharmacological treatments for degenerative disc disease

A

hot/cold compress
weight loss/management
muscle stretching
exercise
lumbar support belt
alternate periods of rest and activity

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14
Q

_______ is infection of the bone

A

osteomyelitis

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15
Q

7 people who are at risk for osteomyelitis

A

immunocompromised
obesity
geriatric
chronic illness
post-op
long term steroid use
orthopedic surgery

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16
Q

organism that is most likely the source of osteomyelitis

A

staph (MRSA)

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17
Q

reduction of bone mass due to deterioration without ability to replace it

A

osteoporosis

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18
Q

in osteoporosis the bone becomes ________, ________, and _______

A

porous, brittle, fragile

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19
Q

accelerated bone loss within the first 5 years of osteoporosis is caused by lack of _________

A

estrogen

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20
Q

most common complication of elderly

A

osteoporosis

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21
Q

osteoporosis is usually asymptomatic until the first clinical manifestation occurs which is a _______

A

fracture

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22
Q

people with osteoporosis will suffer from ______ fractures

A

compression

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23
Q

physical signs of osteoporosis

A

changes in height
kyphosis
protruding abdomen

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24
Q

low vitamin ____ levels put you at risk for osteoporosis

A

D

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25
Q

category of people most at risk for osteoporosis

A

thin postmenopausal women

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26
Q

long term _____ use can lead to osteoporosis

A

steroid

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27
Q

______ ______ _______ drugs can put you at risk for osteoporosis

A

proton pump inhibitor

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28
Q

birth control that can put you at risk for osteoporosis

A

Depo-Provera

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29
Q

hypo__________ and ________ disease can put you at risk for osteoporosis

A

parathyroidism, cushings

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30
Q

osteopenia is low bone mineral ______

A

density

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31
Q

osteopenia is a precursor for ________

A

osteoporosis

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32
Q

most accurate diagnostic test for osteoporosis

A

DEXA scan

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33
Q

3 drug classes used to treat osteoporosis

A

biphosphonates
estrogen agonists antagonists
RANKL inhibitors

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34
Q

biphosphonates can be taken daily, weekly, monthly ____ or quarterly or annually ____

A

PO, IV

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35
Q

estrogen agonists antagonists example

A

Raloxifene (Evista)

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36
Q

estrogen agonists antagonists can be taken ____ daily

A

PO

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37
Q

RANKL inhibitor example

A

Denosumab (prolia)

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38
Q

RANKL inhibitors can be taken ____ every 6 month

A

SQ

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39
Q

2 supplements than prevent bone loss

A

vitamin D
calcium

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40
Q

vitamin ___ is needed to adsorb calcium

A

D

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41
Q

most important side effect of biphosphonates

A

GI problems

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42
Q

most common GI problem with biphosphonates

A

dyspepsia (reflux)

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43
Q

4 teaching points with bisphosphonates

A

empty stomach
sit up 30-40 mins after
NOT for bedbound pts.
encourage weigh bearing exercises

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44
Q

3 serum diagnostics that help diagnose bone conditions

A

calcium
vitamin D
ALP

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45
Q

2 physical signs of osteomalacia

A

bow legged
kyphosis

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46
Q

osteomalacia can be caused by decreased vitamin ___ and failed _____ absorption

A

D, calcium

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47
Q

4 causes of osteomalacia

A

hyperparathyroidism
GI issues
malnutrition
long term anticonvulsant use

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48
Q

3 additional treatments for osteomalacia

A

sunlight exposure
calcium-rich foods (milk)
walking devices

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49
Q

in osteomalacia, X-ray will show __________ of the bone

A

demineralization

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50
Q

in osteomalacia, the pt. will have low ______, but high _____

A

calcium, ALP

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51
Q

2 cranial nerves to assess in someone with Paget’s disease

A

4 and 8

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52
Q

3 nursing considerations for someone with Paget’s disease

A

risk for falls
pain management
hearing loss

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53
Q

malignant bone tumor

A

osteosarcoma

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54
Q

benign bone tumor

A

osteoma

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55
Q

osteomas cause bone _____ while osteosarcomas cause bone _______

A

formation, destruction

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56
Q

both types of bone tumors will cause pathological _______

A

fractures

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57
Q

5 s/s of osteosarcoma

A

constant or occasional pain
weight loss
malaise
fever
mobility issues

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58
Q

2 serum diagnostic tests that will be elevated with osteosarcoma

A

calcium
ALP

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59
Q

bone scans detect radioactive material and are specific to diagnosing ______ and _______

A

osteosarcoma and osteomyelitis

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60
Q

3 treatments for osteosarcoma

A

surgical removal
radiation
chemotherapy

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61
Q

injury to a joint that causes adjoining bones to longer touch each other

A

dislocation

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62
Q

minor or incomplete dislocation in which the joint surfaces are still touching, but are not in normal relation to each other

A

subluxation

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63
Q

dislocation and subluxation are both _______

A

emergencies!!!

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64
Q

condition that occurs when there is not blood supply to the bone

A

avascular necrosis

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65
Q

4 complications that can occur with untreated dislocation/subluxation

A

avascular necrosis
muscle strain
ligament and tendon sprain
nerve damage

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66
Q

arthritis caused by an autoimmune disease

A

rheumatoid

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67
Q

arthritis caused by trauma/wear and tear on the bones and joints

A

osteoarthritis

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68
Q

arthritis caused by an infection in the joint

A

septic arthritis

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69
Q

population more at risk for osteoarthritis

A

women over age of 50

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70
Q

osteoarthritis is usually ______ lateral unless it is in the knees

A

unilateral

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71
Q

serum diagnostic test used to diagnose osteoarthritis

A

rheumatoid factor

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72
Q

serum diagnostic test used to diagnose gout

A

uric acid

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73
Q

elevated uric acid can also cause ______ ______

A

kidney stones

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74
Q

radiologic test used to diagnose osteoarthritis

A

X-ray

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75
Q

x-ray is always done first to rule out _______ ______

A

avascular necrosis

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76
Q

a ______ is the injury to ligaments and tendons around a joint caused by hyperflexion or twisting of the joint

A

sprain

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77
Q

a _____ is an injury to muscles or ligaments caused by overuse or excessive stress on the muscle or ligament

A

strain

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78
Q

2 things that help you figure out what degree the sprain/strain is

A

ROM and pain level

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79
Q

used intermittent cold packs for the first ___ to ___ hours after a sprain or strain

A

24-72

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80
Q

3rd degree sprains/strains needs to be _________ to keep the joint from losing stability

A

immobilized

81
Q

with a 3rd degree sprain/strain you must do a ______ to rule out avascular necrosis

A

x-ray

82
Q

with sprain/strain, report decreased sensation, decreased motion, and increased pain to avoid ______ syndrome

A

compartment

83
Q

5 most common complications with MS injuries and surgeries

A

DVT
infection
avascular necrosis
compartment syndrome
fat embolism

84
Q

first complaint with avascular necrosis

A

pain

85
Q

ages ___ to ___ are at risk for AVN

A

30-50

86
Q

______ and _____ use are associated with AVN

A

steroid, alcohol

87
Q

2 diseases associated with AVN

A

Gaucher
Caisson

88
Q

2 procedures that are associated with AVN

A

chemotherapy
radiation

89
Q

3 treatments for AVN

A

NSAIDs
traction
joint replacement

90
Q

edema/bleeding that is caused by an increase in pressure in a compartment that results in tissue death and dysfunction

A

compartment syndrome

91
Q

pain associated with compartment syndrome

A

pain not relieved with meds

92
Q

most common patient at risk for compartment syndrome

A

patients with a cast

93
Q

compartment syndrome is more common in athletes under the age of ____

A

30

94
Q

compartment syndrome is more common in people who do _____ _____ exercising like running

A

repetitive impact

95
Q

surgical intervention for compartment syndrome

A

fasciectomy

96
Q

orthopedic trauma puts you at risk for a ______ _____

A

fat embolism

97
Q

_____ ____ fractures put you most at risk for fat embolism

A

long bone

98
Q

fat embolisms occur ___ to ____ hours after fracture

A

24-72

99
Q

7 s/s of a fat embolism

A

SOB
tachycardia
rash
hypoxia
confusion
tachypnea
chest pain

100
Q

medications given to prevent fat embolisms

A

blood thinner and corticosteroids

101
Q

_____ _____ filters can be used to prevent a fat embolism

A

vena cava

102
Q

2 allergies to assess for before CT scan with contrast

A

shellfish
iodine

103
Q

levels to check before IV contrast dye is administered because it can cause further damage to this organ

A

BUN and creatine

104
Q

3 uses for external fixators

A
  • complicated fractures with soft tissue damage
  • lengthen limbs
  • nonunion fractures
105
Q

external fixators can lead to _____

A

osteomyelitis

106
Q

most ominous (obvious) sign of compartment syndrome

A

pulselessness

107
Q

first sign of compartment syndrome

A

pain unrelieved with medication

108
Q

plaster casting takes ___ to ___ hours to dry

A

24-72

109
Q

avoid covering plaster cast while drying to avoid ____ injury

A

heat

110
Q

handle wet plaster cast with ____ to avoid pressure areas

A

palms

111
Q

patients with planta fasciitis may get _________ injections

A

corticosteroid

112
Q

Buck’s traction is a ____ traction

A

skin

113
Q

keep leg in _____ position when applying traction

A

neutral

114
Q

3 things to monitor/assess with traction

A

wrinkling of bandage
skin breakdown
nerve status and circulation

115
Q

patient getting AKA should be in ____ position

A

supine

116
Q

do not _____ the limb after AKA because it can cause hip contractures

A

elevate

117
Q

macular degeneration causes loss of _____ vision

A

central

118
Q

glaucoma causes loss of ______ vision

A

peripheral

119
Q

cataracts causes _____ of the lens

A

opacity

120
Q

____ angle glaucoma has a gradual onset, angle appears normal, and ocular pressure may be increased

A

wide

121
Q

_____ angle glaucoma has a rapid onset, increased ocular pressure, headache, loss of central vision, and pupils will be fixed and nonreactive

A

narrow

122
Q

_____ angled glaucoma is an ocular emergency

A

narrow

123
Q

glaucoma med that causes constriction of the pupil and increases the space between iris and lens

A

cholinergics

124
Q

glaucoma meds that boost uveosclera outflow by dilating vessels

A

prostaglandin analogs

125
Q

glaucoma meds that decreased aqueous humor production (3)

A

beta blockers
alpha-adrenergic agonists
carbonic anhydrase inhibitors

126
Q

cholinergcs expire after __ months at room temp

A

2

127
Q

avoid dimly lit areas with ______

A

cholinergics

128
Q

prostaglandins can cause ____ of the iris

A

darkening

129
Q

4 things beta-blockers are contraindicated in

A

COPD
asthma
heart blocks
bradycardia

130
Q

3 s/e of alpha agonists

A

redness of eyes
dry mouth
dry nasal passages

131
Q

avoid ____ allergies with carbonic anhydrase inhibitors and watch for _____ imbalances

A

sulfa, electrolyte

132
Q

patients should wear eye _____ post op cataracts surgery

A

shield

133
Q

medications given post-op with cataracts surgery

A

mild analgesic
antibiotics
anti-inflammatory/steroid

134
Q

a ______ feeling is normal after cataract surgery

A

scratchy

135
Q

5 abnormal symptoms after cataracts surgery

A

floaters
flashing lights
decrease in vision
pain
redness

136
Q

5 s/s of retinal detachment

A

sudden floaters
flashes
blurred vision
reduced peripheral vision
curtain-like shadow over field of view

137
Q

3 assessment findings of a patient with conjunctivitis

A

redness
discharge
crustiness

138
Q

4 things the patient may report when they have conjunctivitis

A

foreign body sensation
itchiness
scratching/burning
photophobia (discomfort with bright light)

139
Q

always wear gloves when touching a patient’s eye with ________

A

conjunctivitis

140
Q

______ conjunctivitis is associated with a history of upper respiratory tract infection

A

viral

141
Q

2 organisms that cause viral conjunctivitis

A

adenovirus
H. simplex

142
Q

if you have conjunctivitis you should not go to school or work for __ to __ days

A

5-7

143
Q

administer eyedrops for conjunctivitis in the ____ ____ of the eye

A

inner canther

144
Q

2 side effects that can occur with someone who is having cerumen impaction irrigation

A

vertigo
dizziness

145
Q

cerumen impaction irrigation can cause perforation of the ______ _____

A

tympanic membrane

146
Q

both otitis media and externa are treated with ________

A

antibiotics

147
Q

do not get ear wet for __ to __ days when getting treatment for otitis media

A

3-7

148
Q

avoid exposure to ______ if you have otitis media

A

smoking

149
Q

3 symptoms you should report when you have otitis media

A

ear pain (otalgia)
purulent drainage
conductive hearing loss

150
Q

when administering ear drops, pull the pinna _____ and back in adults

A

up

151
Q

when administering ear drops, pull the pinna _____ and back in children

A

down

152
Q

acute and chronic otitis media can cause tympanic membrane _______

A

perforation

153
Q

periodic condition of the inner ear affecting fluid balance as a result of head injury or trauma

A

vertigo

154
Q

abnormality of inner ear fluid balance

A

Meniere’s disease

155
Q

triad of symptoms that characterize Meniere’s disease

A

vertigo
tinnitus
hearing loss

156
Q

4 medications for Meniere’s disease

A

antihistamines
tranquilizers
antiemetics
diuretics

157
Q

antihistamine for Menieres disease

A

Antivert

158
Q

tranquilizer taken for Meniere’s disease

A

valium

159
Q

antiemetic for Meniere’s disease

A

phenegran

160
Q

2 surgical treatments for Meniere’s disease

A

shunting of fluid
vestibular nerve sectioning

161
Q

you should decrease _____ intake and increase _____ intake with Meniere’s disease

A

salt, water

162
Q

4 things to avoid with Meniere’s disease

A

caffeine
alcohol
aspirin
MSG (monsodium glutamate)

163
Q

race, age, and gender most as risk for CVA

A

African American males over 55

164
Q

most common CVA

A

ischemic stroke (87%)

165
Q

most fatal CVA

A

hemorrhagic (50%)

166
Q

______ stroke results from vascular occlusion (blood clot) that blocks or narrows an artery leading to the brain

A

ischemic

167
Q

_______ stroke occurs when a blood vessel in the brain ruptures or bleeds

A

hemorrhagic

168
Q

imaging study that determines what kind of stroke it is

A

CT scan

169
Q

imaging that allows you to see the vessels in the brain

A

MRI

170
Q

two imaging studies that are necessary to diagnose a CVA

A

CT scan
MRI

171
Q

diagnostic studies that are beneficial in diagnosing the cause of the CVA

A

carotid ultrasound
EKG

172
Q

medication used to treat an emergent ischemic stroke

A

tPA

173
Q

tPA helps restore ____ ____ to the brain region affected by the stroke

A

blood flow

174
Q

tPA must be administered within ___ hours of symptom onset, but the goal is within __ hour of arrival

A

3, 1

175
Q

tPA is administered via ___ and is _____ based

A

IV, weight

176
Q

4 things required to know before administering tPA

A

BP
weight
past medical history
time and onset of stroke symptoms

177
Q

if you patient is on warfarin you must check ____ levels before administering tPA

A

INR

178
Q

complication that could happen with tPA

A

worse bleeding in the brain

179
Q

you should monitor your patient in tPA every ____ minutes for the first 2 hours

A

15

180
Q

if the patients INR is greater than ___ they cannot get tPA

A

1.7

181
Q

if the patient had head trauma/injury less than __ months ago they cannot get tPA

A

3

182
Q

if the patient has had a stroke less than ___ months ago they cannot get tPA

A

3

183
Q

if your patient has had a GI bleed less than ___ months ago then they cannot get tPA

A

3

184
Q

______ women cannot get tPA

A

pregnant

185
Q

if your patient have ______ they cannot get tPA because it worsens it

A

hypotension

186
Q

if you patient has _______ then they cannot get tPA

A

thrombocytopenia

187
Q

if your patient has had major surgery in the past ____ days then they cannot get tPA

A

14

188
Q

if your patient has a _____ ____ or a ___ they cannot get tPA

A

foley catheter, IVs

189
Q

tPA can cause increased _____ ______

A

intracranial pressure

190
Q

if your patient is on tPA and has increased ICP you can administer _______

A

Mannitol

191
Q

Mannitol is a ______ _____ that draws water out of brain cells and pulls it into the blood stream

A

osmotic diuretic

192
Q

elevated the HOB to ____ degrees if they are on tPA

A

30

193
Q

2 medications given for a non-emergent stroke

A

anticoagulants
platelet inhibitors

194
Q

5 complications of hemorrhagic stroke

A

rebleed
hematoma
hydrocephalus
hypoxia
vasospasm

195
Q

to prevent vasospasm post hemorrhagic stroke you can control _____ _____

A

blood pressure

196
Q

calcium channel blocker given to control BP in order to prevent a vasospasm post-hemorrhagic stroke

A

nimodipine (nymalize)

197
Q

homeostatic mechanisms to avoid hypotension and hypertension to prevent vasospasms

A

triple H therapy

198
Q

3 aspects of triple H therapy

A

fluid volume expander - hypervolemia
induced atrial hypertension
hemodilution

Med Surg (10 decks)

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